Adherence and characteristics of participants enrolled in a standardised programme of patient education and exercises for low back pain, GLA:D® Back – a prospective observational study

Abstract

Background Low back pain is often long-lasting, and implementation of low-cost interventions to improve care and minimise its burden is needed. GLA:D® Back is an evidence-based programme consisting of patient education and supervised exercises for people with low back pain, which was implemented nationwide in primary care clinics in Denmark. To assess how the intervention was received and factors influencing adherence to the program, we aimed to evaluate participants’ adherence to the intervention and identified characteristics related to the completion of GLA:D® Back. Specifically, we investigated: 1) level of attendance of participants enrolled in the programme, and 2) participant-related factors associated with low attendance. Methods Primary care clinicians delivered GLA:D® Back, a standardised 10-week programme of 2 educational and 16 supervised exercise sessions, to patients with low back pain. Attendance was defined as low, medium or high based on self-reported number of attended sessions. Additional participant-reported data included demographic characteristics, pain, prognostic risk profiles, self-efficacy, illness-beliefs, function and clinician-reported physical performance tests. Results for high, medium, low, and unknown attendance were reported descriptively. Odds ratios for low attendance compared to medium/high attendance were calculated by including all baseline factors in a mixed-model logistic regression model. Results Of 1730 participants, 52% had high, 23% medium, and 25% low levels of attendance. Level of attendance was not strongly associated with participants’ individual factors, but in combination, prediction of low attendance was fair (AUC 0.77; 95% CI 0.74–0.79). The strongest indicator of low attendance was not completing the baseline questionnaire. Conclusions Most participants of a 10-week low back pain programme attended almost all session. Non-response to the baseline questionnaire was strongly associated with low attendance, whereas individual patient characteristics were weakly related to attendance. Not completing baseline questionnaires might be an early indicator of poor adherence in programs for people with persistent low back pain. Trial registration The Health Research Ethics for Southern Denmark decided there was no need for ethical approval (S-20172000-93). The Danish data collection has obtained authorisation from the Danish Data Protection Agency as part of the University of Southern Denmark’s institutional authorisation (DPA no. 2015-57-0008 SDU no. 17/30591). The trial was registred at ClinicalTrials.gov NCT03570463.

The GLA:D BACK self‐management adherence and competence checklist (SMAC Checklist)—Development, content validity and feasibility

“… Note : Desc: Descriptive items added to the electronic version by developers; E‐COMP: Essential intervention component from intervention description; FC: Feedback from clinicians; FR2: Feedback Research team meeting no. 2; IC + C: Themes from inductive coding mapped to existing checklists [Restore clinician competency checklist (Kent et al, 2019; Ris et al, 2021), the Group Facilitation Competency Checklist (Thomas & Harden, 2008), the CERT (Kent et al, 2019) and The BECCI (Wong et al, 2019)]. …”

“…Also, the patient receipt indicates potential challenges in targeting individual needs ( Joern et al, 2022). Patients are generally satisfied with the intervention and have high adherence to the programme (Ris et al, 2021), but it is perceived differently by patients depending on how messages and communications resonate with the individual's experiences and beliefs about LBP ( Joern et al, 2022).…”

Pain cognitions and impact of low back pain after participation in a self-management program: a qualitative study

“…Most of participants were females reporting LBP for > 1 year, and around 45% had a higher education. On average participants had moderate pain intensities and moderate disability levels at enrolment [ 21 ]. Participation was decided in a dialogue between patient and clinician and involved out-of-pocket payment [ 9 ].…”

Temporal stability of self-reported visual back pain trajectories

“…In short, the GLA:D Back program is a group-based patient education and exercise program targeting patients with persistent or recurrent LBP and a need for improved self-management. 21 , 31 Active registration in the registry is mandatory when the chiropractor or physiotherapist enrolls the patient in the program.…”